SR CONSULTANT MBBS ,MMED ,FAMS singapore, Singapore
Chief Complaint : A 23-year-old male comes with left-side chest pain for one month after a fall while playing soccer. The pain gradually got worsened over time.
History of Present Illness : - the pain was worse for the last 2 days and became constant - before was on and off, usually occurs at night when he is trying to sleep - worse when he moves his L arm - no shortness of breath, no exertion pain, no orthopnea - No fever, no cough
Pertinent Physical Exam: RR 20-22 HR 129 SpO2 100% RA BP 142/83 T 36.9
Alert, nontoxic. Nil pallor HS1S2 L slight reduced AE over the left lung Abdomen soft calves supple
left lateral chest wall tenderness over 4th-6th rib reproducible on palpation nil rashes
Pertinent Laboratory Data: ECG, Full blood count, renal panel, and cardiac enzymes were within normal limits. Chest X-ray performed showed large globular opacity in the left pleural cavity causing a mass effect. CT thorax was performed and showed a Large loculated pleural collection (15 x 15 x 20 cm)
Case Discussion: The impression was a large pleural effusion secondary to trauma a month back. The case was referred to Thoracic surgeons and a large chest drain was inserted.
After 50 ml of blood with clots, a large amount of empyema was drained. The patient was taken for Left UVATS drainage and decortication. Subsequently, he was monitored in the surgical High dependence ward and was discharged well.
References and Acknowledgements (Optional): Radiographs of the chest (Serial Chest X rays
